title: Neoplastic invasion of laryngeal cartilage: reassessment of criteria for diagnosis at MR imaging.
abstract: OBJECTIVE
  To evaluate whether proposed diagnostic criteria applied to magnetic resonance (MR) images of patients with laryngeal and hypopharyngeal carcinoma may be used to distinguish neoplastic from inflammatory involvement of the laryngeal cartilages.
  
  
  METHODS
  The radiologic and histopathologic data in 121 consecutive patients with primary squamous cell carcinoma of the larynx (n = 63) or hypopharynx (n = 58) who underwent MR imaging before laryngectomy formed the basis of this retrospective study. Patient consent for retrospective chart review was waived by the institutional review board. All laryngectomy specimens were processed with a dedicated histopathologic whole-organ slice technique. MR images were evaluated by two readers according to established ("old") and proposed ("new") diagnostic criteria on the basis of the signal intensity behavior of cartilage on T2-weighted images and contrast material-enhanced T1-weighted images compared with that of the adjacent tumor. Specifically, with the new criteria, T2-weighted or postcontrast T1-weighted cartilage signal intensity greater than that of the adjacent tumor was considered to indicate inflammation, and signal intensity similar to that of the adjacent tumor was considered to indicate neoplastic invasion. The results of the MR image interpretation were compared with the histologic reference standard.
  
  
  RESULTS
  The area under the receiver operating characteristic curve for the new criteria (0.94) was nominally but significantly larger than that for the old criteria (0.92) (P = .01). Overall specificity was significantly improved (82% for new vs 74% for old criteria, P < .001) and was greatest for the thyroid cartilage (75% for new vs 54% for old criteria, P < .001) with the new criteria. The sensitivities of the established and the proposed criteria were identical.
  
  
  CONCLUSIONS
  The proposed MR imaging criteria enable improved differentiation of neoplastic cartilage invasion from peritumoral inflammation.
authors.affiliation: Department of Radiology, Geneva University Hospital, Hôpitaux Universitaires de Genève, Geneva 14, Switzerland. minerva.becker@hcuge.ch
authors.forename: Minerva
authors.initials: M
authors.lastname: Becker
authors.forename: Peter
authors.initials: P
authors.lastname: Zbären
authors.forename: Jan Walther
authors.initials: JW
authors.lastname: Casselman
authors.forename: Romain
authors.initials: R
authors.lastname: Kohler
authors.forename: Pavel
authors.initials: P
authors.lastname: Dulguerov
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D007817:Laryngeal Cartilages / Q000473:pathology* / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media